MICHAEL PAUL ROTH MD Medical Doctor License verification

Business Entity

CANCELLED

License Type

Medical Doctor

Description

TEMPORARY MEDICAL PERMIT

License Number

125047837

License Status

CANCELLED

Business

First Name

MICHAEL

Middle

PAUL

Last Name

ROTH

Suffix

Business Name

MICHAEL PAUL ROTH MD

Original Issue Date

06/21/2004

Effective Date

06/21/2004

Expiration Date

06/20/2007

City

CHICAGO

State

Zip

60611

County

COOK

Specialty/Qualifier

Internal Medicine

Ever Disciplined

LastModifiedDate

09/22/2006